Glucose metabolism outcomes after pituitary surgery in patients with acromegaly.

AIM: To investigate the impact of pituitary surgery on glucose metabolism and to identify predictors of remission of diabetes after pituitary surgery in patients with acromegaly. METHODS: A national multicenter retrospective study of patients with acromegaly undergoing transsphenoidal surgery for the first time at 33 tertiary Spanish hospitals (ACRO-SPAIN study) was performed. Surgical remission of acromegaly was evaluated according to the 2000 and 2010 criteria. RESULTS: A total of 604 acromegaly patients were included in the study with a total median follow up of 91 months (interquartile range [IQR] 45-163). At the acromegaly diagnosis, 23.8% of the patients had diabetes mellitus (DM) with a median glycated hemoglobin (HbA1c) of 6.9% (IQR 6.4-7.9) [51.9 mmol/mol (IQR 46.4-62.8)]. In the multivariate analysis, older age (odds ratio [OR] 1.02, 95% CI 1.00-1.05), dyslipidemia (OR 5.25, 95% CI 2.81 to 9.79), arthropathy (OR 1.39, 95% CI 2.82 to 9.79), and higher IGF-I levels (OR 1.30, 95% CI 1.05 to 1.60) were associated with a greater prevalence of DM. At the last follow-up visit after surgery, 21.1% of the DM patients (56.7% of them with surgical remission of acromegaly) experienced diabetes remission. The cure rate of DM was more common in older patients (hazard ratio [HR] 1.77, 95% CI 1.31 to 2.43), when surgical cure was achieved (HR 2.10, 95% CI 1.01 to 4.37) and when anterior pituitary function was not affected after surgery (HR 3.38, 95% CI 1.17 to 9.75). CONCLUSION: Glucose metabolism improved in patients with acromegaly after surgery and 21% of the diabetic patients experienced diabetes remission; being more frequent in patients of older age, and those who experienced surgical cure and those with preserved anterior pituitary function after surgery.

Natural history and surgical outcomes of Rathke's cleft cysts: a Spanish multicenter study.

Rathke's cleft cysts (RCC) are a common type of lesion found in the sellar or suprasellar area. They are usually monitored clinically, but in some cases, surgery may be required. However, their natural progression is not yet well understood, and the outcomes of surgery are uncertain. The objective of this study is to evaluate the natural history of Rathke's cleft cysts in patients who are clinically monitored without treatment, and to determine the outcomes of surgery and the incidence of recurrences over time. Design and patients: National multicentric study of patients diagnosed of Rathke's cleft cyst (RCC- Spain) from 2000 onwards and followed in 15 tertiary centers of Spain. A total of 177 patients diagnosed of RCC followed for 67.3 months (6-215) and 88 patients who underwent surgery, (81 patients underwent immediate surgery after diagnosis and 7 later for subsequent growth) followed for 68.8 months (3-235). Results: The cyst size remained stable or decreased in 73.5% (133) of the patients. Only 44 patients (24.3%) experienced a cyst increase and 9 of them (5.1%) experienced an increase greater than 3 mm. In most of the patients who underwent surgery headaches and visual alterations improved, recurrence was observed in 8 (9.1%) after a median time of 96 months, and no predictors of recurrence were discovered. Conclusions: Rathke's cleft cysts without initial compressive symptoms have a low probability of growth, so conservative management is recommended. Patients who undergo transsphenoidal surgery experience rapid clinical improvement, and recurrences are infrequent. However, they can occur after a long period of time, although no predictors of recurrence have been identified.

Pegvisomant and pasireotide in PRL and GH co-secreting vs GH-secreting Pit-NETs.

The objective of the study was to evaluate the efficacy of second-line therapies in patients with acromegaly caused by a growth hormone (GH) and prolactin (PRL) co-secreting pituitary neuroendocrine tumor (GH&PRL-Pit-NET) compared to their efficacy in patients with acromegaly caused by a GH-secreting pituitary neuroendocrine tumor (GH-Pit-NET). This is a multicenter retrospective study of patients with acromegaly on treatment with pasireotide and/or pegvisomant. Patients were classified in two groups: GH&PRL-Pit-NETs when evidence of hyperprolactinemia and immunohistochemistry (IHC) for GH and PRL was positive or if PRL were >200 ng/dL regardless of the PRL-IHC and GH-Pit-NETs when the previously mentioned criteria were not met. A total of 28 cases with GH&PRL-Pit-NETs and 122 with GH-Pit-NETs met the inclusion criteria. GH&PRL-Pit-NETs presented at a younger age, caused hypopituitarism, and were invasive more frequently than GH-Pit-NETs. There were 124 patients treated with pegvisomant and 49 with pasireotide at any time. The efficacy of pegvisomant for IGF-1 normalization was of 81.5% and of pasireotide of 71.4%. No differences in IGF-1 control with pasireotide and with pegvisomant were observed between GH&PRL-Pit-NETs and GH-Pit-NETs. All GH&PRL-Pit-NET cases treated with pasireotide (n = 6) and 82.6% (n = 19/23) of the cases treated with pegvisomant normalized PRL levels. No differences in the rate of IGF-1 control between pegvisomant and pasireotide were detected in patients with GH&PRL-Pit-NETs (84.9% vs 66.7%, P = 0.178). We conclude that despite the more aggressive behavior of GH&PRL-Pit-NETs than GH-Pit-NETs, no differences in the rate of IGF-1 control with pegvisomant and pasireotide were observed between both groups, and both drugs have shown to be effective treatments to control IGF-1 and PRL hypersecretion in these tumors.

Differences between GH and PRL co-secreting and GH-secreting pituitary adenomas. A series of 604 cases.

PURPOSE: To evaluate differences in clinical presentation and in surgical outcomes between growth hormone-secreting pituitary adenomas (GH-PAs) and GH and prolactin co-secreting pituitary adenomas (GH&PRL-PAs). METHODS: Multicenter retrospective study of 604 patients with acromegaly submitted to pituitary surgery. Patients were classified into two groups according to serum PRL levels at diagnosis and immunohistochemistry (IHC) for PRL: a) GH&PRL-PAs when PRL levels were above the upper limit of normal and IHC for GH and PRL was positive or PRL levels were >100ng/and PRL IHC was not available (n=130) and b) GH-PAs who did not meet the previously mentioned criteria (n=474). RESULTS: GH&PRL-PAs represented 21.5% (n=130) of patients with acromegaly. The mean age at diagnosis was lower in GH&PRL-PAs than in GH-PAs (P<0.001). GH&PRL-PAs were more frequently macroadenomas (90.6% vs. 77.4%, P=0.001) and tended to be more invasive (33.6% vs. 24.7%, P=0.057) than GH-PAs. Furthermore, they had presurgical hypopituitarism more frequently (OR 2.8, 95% CI 1.83-4.38). IGF-1 upper limit of normality (ULN) levels at diagnosis were lower in patients with GH&PRL-PAs (median 2.4 [IQR 1.73-3.29] vs. 2.7 [IQR 1.91-3.67], P=0.023). There were no differences in the immediate (41.1% vs 43.3%, P=0.659) or long-term post-surgical acromegaly biochemical cure rate (53.5% vs. 53.1%, P=0.936) between groups. However, there was a higher incidence of permanent arginine-vasopressin deficiency (AVP-D) (7.3% vs. 2.4%, P=0.011) in GH&PRL-PAs patients. CONCLUSIONS: GH&PRL-PAs are responsible for 20% of acromegaly cases. These tumors are more invasive, larger and cause hypopituitarism more frequently than GH-PAs and are diagnosed at an earlier age. The biochemical cure rate is similar between both groups, but patients with GH&PRL-PAs tend to develop permanent postsurgical AVP-D more frequently.

Actualización de probióticos, prebióticos y simbióticos en nutrición clínica / An update on probiotics, prebiotics and symbiotics in clinical nutrition

Se revisa el concepto de prebióticos, probióticos y simbióticos y su empleo en diferentes situaciones de la práctica clínica diaria relacionados con la nutrición clínica. Se analiza su papel en el tratamiento y/o prevención de la diarrea (aguda, por antibióticos, rádica), en la enfermedad inflamatoria intestinal (colitis ulcerosa y reservoritis), sobre la salud colónica (estreñimiento, intestino irritable), hepatopatías (esteatosis y encefalopatía mínima), en pacientes de cuidados intensivos, quirúrgicos y sometidos a trasplante hepático. Si bien parece demostrada su eficacia en la prevención de la diarrea por antibióticos y en la reservoritis en la colitis ulcerosa, son necesarios más estudios para poder establecer recomendaciones en la mayoría de escenarios clínicos. El riesgo de infección asociado al uso de probióticos es relativamente bajo; no obstante, existen grupos seleccionados de pacientes en los que se recomienda emplearos con cautela (como la infusión a nivel yeyunal) (AU)

The concept of prebiotics, probiotics, and symbiotics and their use in different situations of daily clinical practice related to clinical nutrition is reviewed, as well as their role in the treatment/prevention of diarrhea (acute, induced by antibiotics, secondary to radiotherapy), inflammatory bowel disease (ulcerative colitis and pouchitis), in colonic health (constipation, irritable bowel), in liver disease (steatosis and minimum encephalopathy), and in intensive care, surgical, and liver transplantation. While their effectiveness for preventing antibiotic-induced diarrhea and pouchitis in ulcerative colitis appears to be shown, additional studies are needed to establish recommendations in most clinical settings. The risk of infection associated to use of probiotics is relatively low; however, there are selected groups of patients in whom they should be used with caution (as jejunum infusion) (AU)

Nutrición parenteral total en una paciente gestante con pancreatitis aguda e hipertrigliceridemia por déficit de lipoproteín lipasa / Total parenteral nutrition in a pregnant patient with acute pancreatitis and lipoprotein lipase deficiency

Presentamos un caso de pancreatitis aguda severa inducida por hipertrigliceridemia secundaria a déficit de lipoproteín lipasa (LPL) en una paciente gestante con diabetes gestacional, manejada inicialmente con dieta, siendo necesario posteriormente llevar a cabo medidas de soporte nutricional artificial: nutrición parenteral total. El déficit de LPL causa hipertrigliceridemia severa y, frecuentemente, pancreatitis aguda de repetición, situación de difícil manejo y de importante gravedad durante la gestación. La pancreatitis aguda por hipertrigliceridemia familiar supone el 5% de los casos, incluyéndose el déficit de LPL. El objetivo del tratamiento será alcanzar niveles de triglicéridos inferiores a 500 mg/dl, siendo la dieta muy baja en grasa el tratamiento de elección, pudiéndose asociar también fármacos o técnicas de plasmaféresis. La nutrición parenteral total enriquecida en ácidos grasos w3 y glutamina resultó segura y eficaz en la paciente, con un descenso importante de los niveles de triglicéridos (AU)

We present a case of severe acute pancreatitis induced by hypertriglyceridemia secondary to lipoprotein lipase (LPL) deficiency in a pregnant patient with gestational diabetes, initially maneged with diet but it was later necessary to carry out artificial nutricional support measures: total parenteral nutrition. LPL deficiency might cause severe hypertriglyceridemia, repetition acute pancreatitis which is an unwieldy and severe situation during pregnancy. Acute familial hypertriglyceridemia pancreatitis accounts for 5% of cases, including LPL deficiency. The goal of treatment is to reach triglycerides levels below 500 mg/dl, being very low fat diet the treatment of choice, drugs or plasmapheresis techniques can also be associated. TPN enriched in w3 fatty acids and glutamine was safe and effective in our patient with significant decrease in triglyceride levels (AU)

Exposición solar en la enfermedad inflamatoria intestinal ambulatoria: factores predictivos y correlación con la concentración sérica de vitamina D / Sunlight exposure in inflammatory bowel disease outpatients: Predictive factors and correlation with serum vitamin D

Introducción: La exposición solar es el principal determinante del estado de vitaminaD. Nuestro objetivo fue describir las prácticas de exposición y protección solar de una serie de pacientes con enfermedad inflamatoria intestinal (EII) y evaluar su influencia en la concentración sérica de vitaminaD. Pacientes y métodos: Estudio observacional de tipo transversal. Las variables clínico-demográficas se obtuvieron mediante entrevista clínica y revisión de la historia. La evaluación de la exposición solar se realizó mediante el Sun Exposure Questionnaire. La concentración de 25-hidroxivitaminaD (25OHD) se determinó por electroquimioluminiscencia. Se realizaron cuestionarios de calidad de vida, actividad física, ingesta semanal de vitaminaD y hábitos de protección solar. Resultados: Se incluyeron 149 pacientes. En el 69% de los pacientes se registraron valores deficientes o insuficientes de 25OHD. El 67% presentaron una baja exposición solar. Se observó una modesta correlación significativa entre la puntuación total del cuestionario de exposición solar y la concentración de 25OHD en la serie completa (r=0,226; p=0,006) y en verano (r=0,274; p=0,01). La puntuación del cuestionario de protección solar no influyó en la concentración de 25OHD. En el análisis multivariado solo la presencia de actividad clínica se asoció a una exposición solar baja (OR=3,23). Discusión: La exposición solar de acuerdo con el cuestionario empleado fue baja, se asoció a la presencia de actividad clínica y se correlacionó débilmente con la concentración de 25OHD sérica. Se necesitan más estudios que exploren el uso de cuestionarios individuales de exposición solar y su correlación con la vitaminaD sérica en la EII

Introduction: Sunlight exposure is the main source of vitaminD. Our aim was to describe both sun exposure and sun protection behaviour in a series of patients with inflammatory bowel disease (IBD), and to study their potential association with vitaminD concentration. Patients and methods: A cross sectional, observational study. The clinical-demographic variables were obtained via clinical interviews and medical history review. The sunlight exposure assessment was carried out using the Sun Exposure Questionnaire and the concentration of 25-hydroxy vitaminD (25OHD) was measured by an electro-chemiluminescence immunoassay. Questionnaires were conducted on quality of life, physical activity, weekly vitaminD intake and sun protection behaviour. Results: 149 patients were included. In 69% of patients, deficient or insufficient 25OHD values were recorded. 67% showed low sun exposure. A modest significant correlation was observed between the total score of the solar exposure questionnaire and the 25OHD concentration in the complete series (r=0.226, P=.006) and in the summer (r=0.274, P=.01). The sun protection behaviour questionnaire score did not influence the 25OHD concentration. In the multivariate analysis, only the presence of clinical activity was associated with low sun exposure (OR=3.23). Discussion: Sun exposure according to the questionnaire used was low, was associated with the presence of clinical activity and was weakly correlated with serum 25OHD concentration. More studies are needed to explore the use of individual questionnaires for sun exposure and its relationship with vitaminD in patients with IBD

Deficiencia de vitamina D en pacientes ambulatorios con enfermedad inflamatoria intestinal: prevalencia y asociación con la actividad clínica-biológica / Vitamin D deficiency in outpatients with inflammatory bowel disease: prevalence and association with clinical-biological activity

Introducción: los datos sobre la prevalencia del déficit de vitamina D en pacientes con enfermedad inflamatoria intestinal (EII) en España son escasos. Dicha deficiencia podría asociarse a un peor curso evolutivo. Objetivo: determinar la prevalencia de deficiencia de 25-hidroxivitamina D (25OHD) en una cohorte de pacientes ambulatorios con enfermedad inflamatoria intestinal y evaluar su asociación con la actividad clínica-biológica, la calidad de vida y síntomas psicológicos. Material y métodos: estudio observacional unicéntrico de tipo transversal. Las variables de estudio se obtuvieron mediante entrevista clínica, revisión del historial médico y cuestionarios validados (escala de ansiedad y depresión hospitalaria y cuestionario corto de calidad de vida de la EII). La determinación de 25OHD fue hecha en el mismo laboratorio por inmunoanálisis de electroquimioluminiscencia. Resultados: se analizaron 224 pacientes. La prevalencia de deficiencia de vitamina D en enfermedad de Crohn (EC) y colitis ulcerosa (CU) fue de un 33,3% y un 20,3% respectivamente. En EC, la deficiencia de vitamina D se asoció con una mayor actividad clínica (p < 0,001) y una mayor concentración de calprotectina fecal (p = 0,01). En CU, hubo asociación con la actividad clínica (p < 0,001), el uso de esteroides en el último semestre (p = 0,001) y los ingresos hospitalarios en el año previo (p = 0,003). En un subanálisis de 149 pacientes no se observó asociación de vitamina D con la calidad de vida ni con las subpuntuaciones de la escala de ansiedad y depresión hospitalaria. Conclusiones: la deficiencia de vitamina D es frecuente en pacientes con enfermedad inflamatoria intestinal. Se observó una asociación entre su concentración y los índices clínicos de actividad, así como con los niveles de calprotectina fecal en enfermedad de Crohn

Introduction: there are few data on the prevalence of vitamin D deficiency in patients with inflammatory bowel disease (IBD) in Spain. A deficiency could be associated with a worse course of the disease. Aim: to determine the prevalence of 25-hydroxyvitamin D (25OHD) deficiency in a cohort of outpatients with IBD and assess its association with clinical and biological activity, quality of life and psychological symptoms. Methods: a cross-sectional, single-center observational study was performed. The study variables were obtained via clinical interviews, medical chart review and validated questionnaires (Hospital Anxiety and Depression Scale and Short Quality of Life in Inflammatory Bowel Disease Questionnaire). 25OHD was measured in the same laboratory by an electro-chemiluminescence immunoassay. Results: the study included 224 patients. The prevalence of vitamin D deficiency in Crohn's disease and ulcerative colitis was 33.3% and 20.3%, respectively. In Crohn's disease, vitamin D deficiency was associated with a higher clinical activity (p < 0.001) and a higher concentration of fecal calprotectin (p = 0.01). In ulcerative colitis, it was associated with clinical activity (p < 0.001), the use of steroids during the last six months (p = 0.001) and hospital admission during the previous year (p = 0.003). A sub-analysis of 149 patients failed to detect an association between vitamin D and quality of life or the scores of the Hospital Anxiety and Depression Scale. Conclusions: vitamin D deficiency is common in patients with inflammatory bowel disease. An association was found between vitamin D concentration and clinical activity indexes, as well as fecal calprotectin levels in Crohn's disease

Comparison between a multiple daily insulin injection regimen (basal once-daily glargine plus mealtime lispro) and continuous subcutaneous insulin infusion (lispro) using continuous glucose monitoring in metabolically optimized type 1 diabetes patients: A randomized open-labelled parallel study / Comparación entre múltiples dosis de insulina (insulina glargina una vez al día y lispro en las comidas) e infusión subcutánea continua de insulina con monitorización continua de glucosa en pacientes con diabetes tipo 1 metabólicamente optimizados. Estudio randomizado

Background and objective: Advantages of continuous subcutaneous insulin infusion (CSII) over multiple daily injections with glargine (MDI/G) are still uncertain. We compared CSII vs. MDI/G therapy in unselected patients with type 1 diabetes using continuous glucose monitoring (CGSM). The primary end-points were glycaemic control and quality of life (QOL). Methods: A total of 45 patients with long-term diabetes and mean HbA1c values of 8.6 ± 1.8% (70.5 ± 15.4 mmol/mol), previously treated with MDI/NPH, were switched to MDI/G for 6 months and then, unfulfilling therapy CSII indication, were randomly assigned to CSII or MDI/G for another six months. We evaluated QOL (EsDqol) and glycaemic control by measuring HbA1c levels, rate of hypoglycaemia, ketoacidosis and CGSM data. Results: After the first phase (MDI/NPH to MDI/G) there was a significant improvement in total EsDQOL (99.72 ± 18.38 vs. 92.07 ± 17.65; p < 0.028), a 0.5% decrease in HbA1c values (8.4 ± 1.2 vs. 7.9 ± 0.7% [68 ± 9.7 vs. 63 ± 5.5 mmol/mol]; p < 0.032), an improvement in glycaemic variability (standard deviation 66.9 ± 14 vs. 59.4 ± 16 mg/dl; p < 0.05), a decrease in insulin requirements (0.87 ± 0.29 vs. 0.80 ± 0.25 U/kg; p < 0.049), a decrease in number of severe hypoglycaemia episodes (0.44 ± 0.9 vs. 0.05 ± 0.2; p < 0.014), and an increase in periods of normoglycaemia measured with CGSM (15.8 ± 10.9% vs. 23 ± 18.4%; p < 0.003). Six months after randomization, significant improvements were seen in the HbA1c (7.9 ± 0.7 vs. 7 ± 0.6% [63 ± 5.5 vs. 53 ± 4.5 mmol/mol]; p < 0.001) and EsQOL (91.66 ± 22 vs. 84.53 ± 1.63; p < 0.045) only in the CSII group. The HbA1c value was significantly lower when compared with the MDI/G group (CSII 7 ± 0.6% [53 ± 4.5 mmol/mol] vs. MDI/G 7.6 ± 0.9% 59.6 ± 7.7 mmol/mol];p < 0.03). Conclusions: Intensive insulin therapy with CSII vs. MDI/G was associated with better levels of HbA1c in patients with long-term type 1 diabetes (AU)

Introducción y objetivo: Las ventajas de la infusión subcutánea continua de insulina (ISCI) sobre múltiples inyecciones diarias de insulina con glargina (MDI/G) son todavía inciertas. Comparamos ISCI frente a MDI/G en pacientes con diabetes tipo 1 sin indicación de terapia ISCI utilizando la monitorización continua de glucosa (CGSM). Los objetivos primarios fueron el control glucémico y la calidad de vida (QOL). Métodos: Un total de 45 pacientes con diabetes 1 de largo tiempo de evolución y valores medios de HbA1c de 8,6 ± 1,8% (70,5 ± 15,4 mmol/mol), previamente tratados con MDI/NPH, fueron cambiados a MDI/G durante 6 meses y luego sin cumplir criterios clínicos para terapia ISCI asignados aleatoriamente a ISCI o MDI/G durante seis meses. Se evaluó la calidad de vida (EsDqol) y el control de la glucemia mediante la medición de los niveles de HbA1c, la tasa de hipoglucemias, cetoacidosis y datos de CGSM. Resultados: Después de la primera fase (MDI/NPH a MDI/G) hubo una mejora significativa en EsDQOL total (99,72 ± 18,38 vs. 92,07 ± 17,65; p < 0.028), una disminución de 0,5% en los valores de HbA1c (8,4 ± 1,2 vs. 7,9 ± 0,7% [68 ± 9,7 vs. 63 ± 5,5 mmol/mol]; p < 0,032), una mejora en la variabilidad de la glucemia (desviación estándar 66,9 ± 14 vs. 59,4 ± 16 mg/dl; p <0,05), una disminución en las necesidades de insulina (0,87 ± 0,29 vs. 0,80 ± 0,25 U/kg; p <0,049), una disminución en el número de episodios de hipoglucemia grave (0,44 ± 0,9 vs. 0,05 ± 0,2; p <0,014), y un aumento en los periodos de normoglucemia medidos con CGSM (15,8 ± 10,9% vs. 23 ± 18,4%; p <0,003). Seis meses después de la aleatorización, se observaron mejoras significativas en la HbA1c (7,9 ± 0,7 vs. 7 ± 0,6%; [63 ± 5,5 vs. 53 ± 4.5 mmol/mol]; p <0,001) y la calidad de vida (91,66 ± 22 vs. 84,53 ± 1,63; p <0,045) sólo en el grupo ISCI. El valour de HbA1c fue significativamente menor en ISCI en comparación con el grupo MDI/G (CSII 7 ± 0,6% [53 ± 4,5 mmol/mol] vs. MDI/G 7,6 ± 0,9% [59,6 ± 7,7 mmol/mol]; p < 0,03). Conclusiones: La terapia insulínica intensiva con ISCI vs. MDI/G se asoció con mejores niveles de HbA1c en pacientes con diabetes tipo 1 de larga evolución (AU)

Relación entre déficit de vitamina D y síndrome metabólico / Relationship between vitamin D deficiency and metabolic syndrome

Fundamento y objetivo: El déficit de vitamina D y el síndrome metabólico son 2 entidades muy frecuentes en población española. Se ha sugerido que los pacientes con síndrome metabólico pueden tener déficit de vitamina D con mayor frecuencia que los sujetos sin e'l, y que unos valores bajos de vitamina D pueden predisponer al desarrollo de síndrome metabólico. No obstante, los resultados de estudios prospectivos y de intervención han sido diversos, sin que se haya aclarado por el momento si existe esta relación. El objetivo de este trabajo fue evaluar la relación entre los valores de 25-hidroxivitamina D y la prevalencia e incidencia del síndrome metabólico. Pacientes y método: Se realizó un estudio poblacional de cohortes. Al inicio del estudio (1996-1998), 1.226 pacientes fueron evaluados. Las visitas de seguimiento se llevaron a cabo en 2002-2004 y 2005-2007. Basalmente y durante el seguimiento, los participantes se sometieron a una entrevista y un examen clínico estandarizado con una prueba de tolerancia oral a la glucosa. En la segunda visita se midieron la 25-hidroxivitamina D y los valores de parathormona intacta. Resultados: La prevalencia de síndrome metabólico en la segunda y la tercera evaluación fue del 29,4 y del 42,5%, respectivamente. Los valores medios (DE) de 25-hidroxivitamina D fueron menores en los pacientes con síndrome metabólico, 21,7 (6,21) frente a 23,35 (6,29) ng/ml, p < 0,001. La prevalencia de deficiencia de vitamina D (25-hidroxivitamina D < 20 ng/ml) en la segunda evaluación fue del 34,7%, con diferencias significativas entre los sujetos con y sin síndrome metabólico (34,6 frente a 26,5%, p < 0,01). Los varones con deficiencia de vitamina D tuvieron con mayor frecuencia hipertensión y síndrome metabólico que aquellos con valores normales. Las mujeres con deficiencia de vitamina D tuvieron más frecuentemente hiperglucemia, hipertensión, aumento de la circunferencia de la cintura e hipertrigliceridemia. En el estudio prospectivo, los valores de 25-hidroxivitamina D < 20 ng/ml no se asociaron significativamente con un mayor riesgo de desarrollar el síndrome metabólico en los siguientes 5 años (odds ratio 0,99, intervalo de confianza del 95% 0,57-1,7, p < 0,97) después de ajustar por sexo y edad. Conclusiones: Los pacientes con síndrome metabólico tienen con mayor frecuencia déficit de vitamina D, pero este no predice el riesgo de desarrollar síndrome metabólico (AU)

Background and objective: Vitamin D deficiency and metabolic syndrome are 2 very common health problems in the Spanish population. It has been suggested that patients with metabolic syndrome may be vitamin D deficient more often than subjects without it and that low vitamin D levels may predispose to metabolic syndrome development. However, the results of prospective and intervention studies have been different and such relationship remains unclear. We assessed the relationship between 25-hydroxyvitamin D levels and the prevalence and incidence of metabolic syndrome. Patients and methods: We undertook a population-based cohort study in Spain. At baseline (1996-1998), 1,226 subjects were evaluated. Follow-up visits were performed in 2002-2004 and 2005-2007.At baseline and follow-up, participants underwent an interview and a standardized clinical examination with an oral glucose tolerance test in those subjects without known diabetes. At the second visit, 25-hydroxyvitamin D levels and intact parathyroid hormone levels were measured. Results: The prevalence of metabolic syndrome at the second and third visit was 29.4 and 42.5%, respectively. Mean levels of 25-hydroxyvitamin D were lower in subjects with metabolic syndrome: 21.7 (6.21) vs 23.35 (6.29) ng/ml, P < .001.The prevalence of vitamin D deficiency (25-hydroxyvitamin D < 20 ng/ml) at the second evaluation was 34.7%, with significant differences between subjects with and without metabolic syndrome(34.6 vs 26.5%, P < .01). Men with vitamin D deficiency had more frequently hypertension and metabolic syndrome than men with normal levels. Women with vitamin D deficiency had more frequently hyperglycemia, hypertension, increased waist circumference and hypertriglyceridemia. In a prospective study, 25-hydroxyvitaminD values < 20 ng/ml were not significantly associated with an increased risk of developing metabolic syndrome in the next 5 years (odds ratio 0,99, 95% confidence interval 0.57-1.7, P = .97) after adjusting by sex and age. Conclusions: Vitamin D deficiency is associated with an increased prevalence but not with an increased incidence of metabolic syndrome (AU)

Hipoglucemias persistentes en paciente intervenida de cirugía bariátrica / Persistent hypoglycemia in a patient with bariatric surgery

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Trasplante hepático en tumor carcinoide de páncreas metastático / Liver transplantation for pancreatic carcinoid tumor with metastasis

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Depresión en la diabetes mellitus tipo 1 y factores asociados / Depression in type 1 diabetes mellitus and associated factors

Fundamento y objetivo: En los últimos años ha aumentado el interés por la depresión y los factores de riesgo en diabetes. Objetivos: 1) estudiar las variables asociadas a la presencia de depresión en pacientes con diabetes mellitus tipo 1 (DM1); 2) analizar posibles factores de riesgo de depresión en estos pacientes; 3) determinar un posible modelo explicativo de las puntuaciones de depresión en este tipo de pacientes. Pacientes y método: Doscientos siete pacientes con DM tipo 1. Las variables sociodemográficas y biomédicas fueron evaluadas mediante entrevista estructurada y las variables psicológicas mediante la Escala de Depresión en Diabetes Tipo 1 (EDDI-1) y la Versión española del Diabetes Quality of Life (Es DQOL). Resultados: La prevalencia de depresión fue del 21,7%. Variables asociadas con riesgo de depresión en la muestra estudiada: ser mujer; no estar empleado; fumador; tener complicaciones por la diabetes u otra afección física; no percibir apoyo de la familia, amigos ni compañeros de trabajo en relación a la diabetes; número elevado de hiperglucemias semanales; y baja calidad de vida. Se ha obtenido un modelo, basado en investigaciones previas, que explica un alto porcentaje de la variabilidad en las puntuaciones de los pacientes en la Escala de Depresión en Diabetes Tipo 1.Conclusiones: Estos resultados proporcionan apoyo empírico sobre los factores de riesgo asociados a la depresión en pacientes con DM tipo1. Las variables control glucémico y calidad de vida han tenido un peso importante en las puntuaciones de la Escala de Depresión en Diabetes Tipo 1, lo que aporta una valiosa información para la planificación del tratamiento de estos pacientes (AU)

Background and objective: In recent years, there has been an increased interest in depression and diabetes risk factors. Our objectives were 1) Study the variables associated with the presence of depression in patients with type 1 diabetes mellitus (DM1), 2) to analyze potential risk factors for depression in these patients, and 3) to study a possible explanatory model of depression scores in these patients.Patients and methods: 207 patients with DM1. We evaluated sociodemographic and biomedical variables by means of a structured interview. We assessed psychological variables by means of the Scale for Depression in Type 1 Diabetes (EDDI-1) and the Spanish version of Diabetes Quality of Life (Es DQOL).Results: Prevalence of depression was 21,7%. Variables associated with risk of depression in this sample were to be female; be unemployed; smoking; having complications of diabetes or other physical conditions; not perceiving family support or support from friends or colleagues in relation to diabetes; having a high number of weekly hyperglycemia; and a poor quality of life. A model based on previous research was obtained. This model explains a high percentage of the variability in the scores of patients in the EDDI-1. Conclusions: These results provide an empirical support to the knowledge of the risk factors associated with depression in patients with DM1. Glycemic control and quality of life have an important effect on the scores of depression in these patients, providing information for their treatment (AU)